Insurance Providers that Understand the Value of Primary Care - Fixing The Primary Care Crisis

Some insurers are developing new approaches to primary care that are having a real impact in improving quality while also reducing overall costs. Some examples:

CareFirst Blue Cross Blue Shield believed that good care coordination would improve the quality of care for the patient with a chronic illness while reducing costs by eliminating excess visits, tests, and procedures. Hence, Carefirst instituted a new program that incents PCPs with opportunities for increased income in return for providing effective chronic illness care coordination. More than three years into the program, the results are clear: care is improved, patient and PCP satisfaction has improved, and the savings in total costs of care have been reduced-all with lessened referrals to specialists and reduced hospitalizations.

Erickson Living Medicare Advantage Plan for residents of their group of 18 continuing care retirement communities sets the patient number per doctor at a remarkably low 400 for their in-house PCPs. They have found that this is the ideal number of geriatric patients per doctor in order to assure the type, quality, humanistic, integrative approach to care which I have described throughout this book. They have clearly demonstrated that this not only gives superior care but that it results in much reduced total costs. Other benefits: Unlike Traditional Medicare where one must spend three days in the hospital in order to be eligible for Medicare to pay for the first 100 days of residential skilled nursing care, this Advantage plan waives the required three day stay. In other words, if the resident would benefit, the doctor can make the decision and can arrange immediate referral to their on campus site. This of course eliminates a very costly hospitalization off campus. Most residents find that their total expenses are substantially less than they were paying when they had traditional Medicare.

These are just two examples of how innovative insurers are changing the paradigm so that patients, especially those with complex chronic illnesses, can get better primary care as a result of increased time with their PCP including good preventive care, care of chronic illnesses and care coordination of specialists when needed



Copyright (c) Stephen C. Schimpff, MD